Team Approach Advocated to Improve Multiple Sclerosis Relapse Care

Successful relapse management of multiple sclerosis (MS) requires a multidisciplinary team that is involved during the multiple stages of patient care, according to a presentation at the Consortium of Multiple Sclerosis Centers Annual Meeting.

“MS care takes a team-based approach,” said presenter Colleen Harris, MN, NP, MSCN, of the University of Calgary Multiple Sclerosis Clinic, Calgary, Alberta, Canada, in an interview with Clinical Pain Advisor. “Often it may be a nurse at the frontline recognizing some symptoms suggestive of a relapse. Then it is confirmed by either a [nurse practitioner] or neurologist in the field of MS. And if there is significant functional impact, we rely on our rehab colleagues to assist us in full recovery.”

In all, she said the MS team includes neurologists; nurses; support staff; urologists; neuropsychologists; speech therapists; physical, recreational and occupational therapists; social workers/counselors; ancillary services; and the National Multiple Sclerosis Society/Multiple Sclerosis Association of America.

During her presentation, Harris also defined MS relapse, which she said is new symptoms of neurological dysfunction or worsening of symptoms that have been stable for the last 30 days of acute or subacute onset and lasting more than 24 hours.

Although there has not been much change over the years with regard to relapse treatment, she said what has changed is the meaning of relapse.

“Now, it means that we are not treating patients with therapies that should reduce and, in many cases, eliminate relapses,” she said, stressing that symptom change may not mean a relapse. “If a neurology practice doesn't see a lot of MS patients, they may misinterpret symptom change as a relapse. If symptom change doesn't meet the definition [for relapse], we have to look for a systemic infection. The most common culprit is urinary tract infection.”

Currently, despite the availability of good treatments for MS, Harris said patients with the condition still do have relapses, which is a signal that their disease is active and that they are not being treated appropriately. “Some of [the relapses] can be quite incapacitating, depending on the location of the relapse and how it impacts the patient functionally,” she said.

When it looks like a patient is having a relapse, the first step is to correctly identify it as a relapse, ruling out any other contributing factors, such as systemic infection or a complication resulting from one of the treatments.

“We look at MS relapses differently now that we have treatments to control them. Corticosteroids and [adrenocorticotropic hormone therapy] are still the mainstay of treatment for relapses,” Harris said. “But appropriate relapse recognition is paramount. If individuals do relapse, they need the treatment and … if they're significantly functionally impaired, they will need to see a rehab specialist.”